Drugs in labour and birth
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Amma Kyei-Mensah

Consultant in Obstetrics and Gynaecology. Lead obstetrician in maternal medicine at The Whittington Hospital in London.
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Birth and Labour

What are the implications of premature birth?

A premature birth may have various effects on babies - including their growth, weight, strength, and development.
In Short

If you are likely to give birth prematurely – e.g. you have underlying medical problems, a multiple pregnancy you may be advised to book for antenatal care at a hospital with facilities for caring for premature babies. The hospital should have a neonatal intensive care unit (NICU).

Premature babies may have problems because they are born early. A baby is considered premature if it is born before 37 weeks.

The paediatricians caring for premature babies are called neonatologists. When assessing the baby they will use the expected date of delivery rather than the real date of birth as a more realistic indicator of their development.

Breast milk is ideal for a premature baby. Breastfeeding reduces the risk of gut inflammation which is commoner in these babies because the gut is immature.

The baby’s immune system is also immature and breast milk encourages healthy colonisation of the gut with good bacteria (microbiome).

Management of pregnancies at risk of early delivery

If you begin having contractions prematurely, the doctors will try to determine the cause so that they can decide if it is safe to give you medication (tocolytic drugs) to stop the contractions. If there is bleeding or any sign of infection, tocolytics will not be given.

If it is safe to stop the contractions, tocolytics will be given to allow time for administration of 2 steroid injections.

Management of threatened premature labour

If you begin having contractions prematurely the doctors will try to determine the cause so that they can decide if it is safe to give you medication (tocolytic drugs) to stop the contractions. If there is bleeding or any sign of infection, tocolytics will not be given.

If it is safe to stop the contractions, tocolytics will be given to allow time for administration of 2 steroid injections.

What are steroids used for in threatened premature labour?

A premature baby has immature lungs. Steroid injections are used to help mature a premature baby’s lungs so they produce surfactant. Surfactant allows the lung tissue to inflate correctly in the baby’s lung so that it breathes properly after delivery. Without surfactant, it is very hard to get air into the baby’s lung.

Steroids are ideally given at least 48 hours before an expected premature delivery so that they have begun to take effect. This may not be possible if the onset of labour is sudden and rapid. Sometimes these steroids can have a negative impact of your breastmilk production so you will need additional support to feed or express your milk early, within the first 2 hours after birth, frequently 8-10 times in 24 hours including night time and effectively, hand expressing, to begin with followed by pumping with an electric breast pump.

What are the long-term effects of prematurity?

This depends greatly on the degree of prematurity. A baby born at only 24 weeks may have many more problems than a baby born at 36 weeks. The state of the baby’s lungs is the primary factor influencing the management of premature babies. If the lungs are working well, the baby’s progress is usually good. Lung problems can affect the baby’s progress and prolong the need for specialist care and treatment. Disability risk is related to the degree of prematurity and to any other underlying factors such as the presence of congenital abnormality e.g. cardiac structural problems, gut problems etc

Development of babies born prematurely

Paediatricians use the expected date of delivery rather than the real date of birth as a more realistic indicator of their development. Premature babies are regularly screened at intervals for potential disability and neurodevelopmental problems. Babies will undergo standard neurodevelopment screening. They may have video assessment to monitor the development of their motor skills. Many low-birthweight babies including premature babies are included in longitudinal studies to assess their development and offer early intervention if needed.

Growth in babies born prematurely

Premature babies are often smaller than their full-term peers. Their weight gain can lag behind so it takes longer to catch up to their ideal centile for weight and height. Your baby’s medical team (nurses, doctors, health visitors) will concentrate on achieving steady growth in terms of weight, head circumference, and length.

Growing steadily is more important than moving to a higher centile for weight and height.

The video below gives some breastfeeding tips

Breastfeeding tips

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.